A&E by appointment only as ICB reveals radical plans for acute care

An ICB has drawn up plans to overhaul acute care in its area, including mandatory appointment booking for A&E departments and triage though ‘neighbourhood hubs’.

Cambridgeshire and Peterborough ICB said it is planning to launch pilots of the strategy from December, aiming to shift from ‘traditional acute care to a community-based approach’.

According to a draft of the strategy, seen by Pulse, other than for blue light emergencies, patients will not access any A&E department ‘without a booked appointment slot’.

It also suggests:

• Acute triage being delivered through ‘neighbourhood health hubs’;
• An extra emphasis on patient self-care, which will involve advice from the health hubs;
• Using AI to help triage patients to primary and secondary care services;
• Bringing in locally negotiated GP contracts;
• Topping up funding for GP practices that lose out from the Carr-Hill formula.

This follows similar plans in other ICBs, aimed at bringing in reforms to acute care suggested by NHS England clinical director Dr Claire Fuller.

It is unclear from the Cambridgeshire and Peterborough plans whether acute care will be removed entirely from GP practices.

For emergencies, patients will still be able to call 111 or an ambulance and they will be given assessment by ‘a trained person’ who will be a ‘single point of access’ for them while they are ill.  

It added: ‘In order to ensure we are using all channels for treating people, we need to review access to emergency departments – the first step to this is for all people not arriving by blue light to have an appointment. People will not access any ED department without a booked appointment slot.

This means the MDT and case managers can book people into the department. People as walk-ins will be assessed by the equivalent of the MDT at the front door, with the senior clinical team and be booked into the appropriate service and given the details of people who will be available to support them if there is a problem with the onward treatment point.

‘This is different from the current pathway because people are now triaged and told to wait as long as it takes.’

For non-emergency care, the document provided a series of pathways that involved patients completing ‘a short form’ on the website to ‘receive personalised information’ to help them ‘understand their condition’, or to ‘check for red flag symptoms’.

GPs will have ‘an integrated neighbourhood team’ that will ‘provide intensive support’ for the ‘most complex’ patients and ‘pro-actively’ manage their care.

They will have ‘additional capacity available outside of the practice’ to do tasks ‘not needing’ to be done in the surgery, without ‘negative financial impact on practice sustainability’.

The ICB acknowledged that the Carr-Hill formula is ‘not providing an equal playing field’ for practices and said it would use the investment fund created by the model ‘to level up payments for practices based on health inequalities and deprivation’.

The document said: ‘Of the 87 practices, the 3^rd most deprived is the 66^th worst funded, in the top 20 shown, 60% are in the bottom half of per patient funding. 

‘This programme would address this and level up to ensure practices sustainability whilst giving patients increased access to their GP or an alternative provider for their needs.’

The plan also said that GPs are ‘fundamental’ but ‘hold a level of personal financial liability that other clinicians don’t’.

‘To ensure we can progress this model it is therefore critical that we underwrite the risk for GP practices and enable them to change,’ it added.

‘Firstly, we would propose that locally at an ICB level we have the flexibility to introduce local contracts that would be supported by our practices and our LMC. These contracts would give parity to other providers in providing financial stability over a five year period.’

Pulse has contacted the ICB for comment.

Pulse has also asked the ICB to clarify if under the plans patients would still be able to contact their practice as normal but the ICB has yet to respond.

Earlier this year, Pulse revealed that an ICB is working on plans to overhaul its GP model, which would see patients triaged by 111 call handlers and seen in a ‘neighbourhood hub’.

It comes after North West London ICB was forced to shelve similar plans for same-day access hubs, aimed to ‘deliver a single point of triage for same-day, low complexity’ demand for all 2.1 million residents within the integrated care system, leaving GP practices with only longer-term, ‘complex’ care.

It is however still planning to overhaul its primary care model by April 2025 and it has indicated it will not consult on plans as same-day hubs are a ‘national imperative’.

Pulse has reported on other areas implementing similar models, including in Cornwall where retired GPs will staff hubs to ease on-the-day demand, and Oxfordshire where ‘non-complex’ patients will be dealt with at same-day hubs.